Background. Around 1% of patients who have hip replacement have deep prosthetic joint infection afterwards. Infection is treated with antibiotics and revision surgery. We aimed to characterise the impact of deep joint infection and its treatment, to identify treatment preferences, and to describe surgeons' treatment decisions. Methods. In a qualitative study in the UK we interviewed 19 patients who had infection after hip replacement and 12 orthopaedic surgeons specialising in infection. Face-to-face interviews with patients explored experience of infection, treatment and recovery. Interviews with surgeons explored treatment decisions. With consent, interviews were audio-recorded, transcribed and anonymised. Once imported into QSR NVivo software, data were analysed using constant comparison. Results. Patients with deep joint infection described mobility loss, pain, loss of valued activities, changes to home environments/moving into care, negative impact on personal relationships and financial strain. Physical and psychological trauma was associated with revision surgery and antibiotic treatment. Patients had strong preferences for treatment options, emphasising impact of surgery, side effects of antibiotics and duration of treatment as key considerations. Although eradication of infection was important, patients felt that reducing impact of treatment was high priority and identified a need for more support. Surgeons' treatment decisions focused on patient characteristics and nature of infection to prioritise eradication of infection. During patients' recovery surgeons' were concerned about possible return of infection and patients' mobility and function. Conclusion. Infection after joint replacement causes physical and psychological trauma. Balancing patients' preferences for reducing impact of treatment with surgeons' emphasis on eradication of infection should be an important consideration in care. There is also need to develop new interventions to support patients with infection. Level of evidence. Level 3 –
Movement dysfunction resulting in a knee valgus position during weight bearing activity is associated with increased risk of Anterior Cruciate Ligament injury and Patellofemoral Pain Syndrome especially in young active females. In clinical practice determining the critical knee flexion angle (CKFA) during a single leg squat (SLS) test is used to assess this dysfunction, yet its reliability is unknown. This study aimed to determine rater agreement in determining the presence of knee valgus movement (yes/no) during a SLS test in recreational females (n = 16, age 24.3 ±7.9 yrs, height 165.7±4.8m, mass 62.5±6.4kg) and the intra and inter-rater reliability of measuring CKFA using SiliconCoach™. Three experienced physiotherapists viewed 48 randomised SLS test videos. One physiotherapist repeated the viewing for test-retest analysis. Test-retest agreement for rating SLS test was acceptable (weighted kappa (k) = 0.667). Inter-rater agreement was moderate to substantial (weighted k = 0.284–0.613). Intra-rater reliability of CKFA was acceptable for all three raters (ICC>0.6). Inter-rater absolute reliability was below 5% of the mean CKFA (SEM 4.26 degrees). As previous research reports intra-rater agreement is better than inter-rater agreement when assessing movement dysfunction during functional activity via visual rating. Intra-rater within session and between session reliability for measuring the CKFA using SiliconCoach™ was acceptable and better than inter-rater reliability. Further research is needed to assess the concurrent and construct validity of the protocols used in this study. It is recommended that
